Studying outcomes of organizational change in health services
Studying outcomes of organizational change in health services
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DOI：
10.1097/00005650-199711001-00002
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发表时间：
1997-11-01
期刊：
影响因子：
3
通讯作者：
Lake, ET
中科院分区：
文献类型：
--
作者：
Aiken, LH;Sochalski, J;Lake, ET
目标。提供医疗保健的快速变化的组织环境正在改变提供者与患者的关系和临床决策过程，对患者的治疗结果产生重大影响。然而，缺乏对此类影响的明确研究。作者试图强调组织研究对临床结果研究的贡献，并展示了进一步开展此类努力的几种方法。方法。作者提出了连接操作机制的理论框架；组织属性和患者结果。他们使用正在进行的医院研究中的案例来说明衡量这些机制和克服组织研究中固有的一些可行性问题的策略。结果。探讨了几个方法论问题：（1）利用“机会目标”和“自然实验”是研究与组织改革相关的患者结果的一种有前景的策略； (2) 根据个人调查答复构建的组织特征指数可以阐明结构影响结果的运作机制； (3) 二手数据源和创新的统计匹配程序为构建研究比较组提供了可行的策略。将组织结果研究策略扩展到新的探究领域提供了一个机会，以增强我们对护理组织如何影响结果的理解。结论。在正在进行根本性重组的医疗保健系统中提高医疗保健的有效性需要更好地了解组织环境如何影响临床结果。应更加优先考虑研究人员和资助机构的组织成果研究。 。
OBJECTIVES. The rapidly changing organizational context within which health care is delivered is altering provider-patient relations and processes of clinical decision-making, with significant implications for patient outcomes. Yet definitive research on such effects is lacking, The authors seek to underscore the contribution of organizational research to studies of clinical outcomes and demonstrates several approaches to further such efforts.METHODS. The authors present a theoretical framework of the operant mechanisms linking; organizational attributes and patient outcomes. They use case examples from their ongoing research on hospitals to illustrate strategies for measuring these mechanisms and for overcoming some of the feasibility issues inherent in organizational research.RESULTS. Several methodological issues are explored: (1) exploiting ''targets of opportunity'' and ''natural experiments'' is a promising strategy for studying patient outcomes related to organizational reform; (2) indices of organizational traits, constructed from individual survey responses, can illuminate the operant mechanisms by which structure affects outcomes; and (3) secondary data sources and innovative statistical matching procedures provide a feasible strategy for constructing study comparison groups. Extending the organizational outcomes research strategy to new areas of inquiry offers an opportunity to enhance our understanding of how nursing organization affects outcomes.CONCLUSIONS. Improving the effectiveness of medical care in a health-care system undergoing fundamental restructuring requires greater understanding of how organizational context affects clinical outcomes. A higher priority should be placed on organizational outcomes research by researchers and funding agencies. .